Avoiding the vicious cycle of prolonged opioid use in Crohn's disease.

The decision to use opioid analgesics in the management of chronic pain in patients with Crohn's disease is a complex one. Little is known about the effects of long-term high-dose opioids on cognitive function or risk of opioid addiction. At higher doses, opioids affect the gastrointestinal tract adversely and may result in perturbations of the endocrine and immune systems. Distinguishing functional gastrointestinal symptoms from inflammatory symptoms can further complicate this issue. Cross and colleagues have attempted in a retrospective cross-sectional study to identify factors which may predict narcotic use in patients with Crohn's disease. Increased disease activity, polypharmacy (particularly with neuropsychiatric drugs) and cigarette smoking were found to be independent predictors of chronic narcotic use in these patients. Future research in this area is greatly needed to improve patient care. In patients with Crohn's disease, caution should be exercised when it comes to the liberal use of narcotics.